Evidence map›Paper›PMID 41239165›Full record

ArticleNeurocritical care2026

Practicalities of noninvasive neuromonitoring in intensive care.

Yorinde S Kishna, Chiara Robba, Iwan C C van der Horst, Fabio S Taccone, Sergio Brasil, Stefan Y Bögli, Frederick A Zeiler, Werner H Mess, Marcel Aries

Abstract read
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In one paragraph

Article in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Yorinde S KishnaDepartment of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands. yorinde.kishna@mumc.nl.ORCID 0009-0005-1238-363X
Chiara RobbaIRCCS, Policlínico San Martino, Genoa, Italy.
Iwan C C van der HorstAlbert Schweitzer Hospital, Dordrecht, The Netherlands.
Fabio S TacconeDepartment of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium.
Sergio BrasilDivision of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
Stefan Y BögliDepartment of Neurology and Neurocritical Care Unit, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Frederick A ZeilerDepartment of Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada.
Werner H MessInstitute of Mental Health and Neurosciences (MHeNs), Maastricht University, Maastricht, The Netherlands.
Marcel AriesDepartment of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNoninvasive neuromonitoring provides valuable insights into cerebral physiology and function, with the potential to support individualized care for patients who are critically ill. As precision medicine continues to advance within the intensive care unit, the integration of multiple noninvasive monitoring techniques may offer a more comprehensive, real-time understanding of dynamic cerebral pathophysiology while avoiding the risks of invasive procedures. This study aimed to identify the implementation challenges of combining multiple noninvasive neuromonitoring modalities. Six modalities were selected: blind transcranial Doppler ultrasonography, optic nerve sheath diameter measurement, multichannel continuous electroencephalography (cEEG), automated pupillometry, near-infrared spectroscopy (NIRS), and skull extensometer (Brain4Care).

methodsTo assess the readiness of each modality for integration into a multimodal noninvasive monitoring setup, a group of experts propose the Noninvasive Neuromonitoring Multimodal Readiness (nnMR) score. This scoring system aims to provide a structured evaluation of each modality's multimodal suitability based on criteria such as data continuity and processing, physiological signal representation, spatial and temporal resolution, and software integration in the intensive care unit setting.

resultsnnMR scores showed that cEEG and NIRS enable continuous monitoring without manual processing. Blind transcranial Doppler and NIRS offer a good temporal resolution; optic nerve sheath diameter provides good spatial resolution; cEEG and skull extensometer combine both. Only cEEG demonstrates anatomical clarity. Software integration remains limited across all modalities. Key challenges to multimodal implementation include the need for skilled personnel, artifact susceptibility, mismatched temporal and spatial resolutions, and limited long-term signal stability. Integration into unified analytical platforms is further constrained by a lack of standardization, requiring separate manual data input, processing, and quantification.

conclusionsThe nnMR score was developed to assess the current readiness of each modality for multimodal, continuous, and long-term clinical application. To validate the proposed nnMR score, engagement with the broader neurocritical care community is essential. Realizing the full potential of multimodal neuromonitoring will require advances in signal validation, software integration, resolution alignment, artifact detection, fixation techniques, and standardization, necessitating close collaboration among researchers, engineers, manufacturers, and clinicians.

Indexed as

Critical CareElectroencephalographyNeurophysiological MonitoringHumansIntensive Care UnitsOptic NerveSpectroscopy, Near-InfraredUltrasonography, Doppler, TranscranialMultimodalityNeuromonitoringNoninvasivePractical application

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.